200 Club of Morris Scholarship Application

Deadline for completed applications: March 1, 2018

IMPORTANT: This application must be completed and submitted in one step. You cannot save your work and come back to make edits at a later time. You must include an essay in this online form so we strongly encourage you to have that readily available before you start completing this application.

Your essay should describe how your employment, extracurricular and community service activities have impacted and influenced your life and future direction. The 200 Club Scholarship Committee receives nearly 100 applications and only awards up to 25 scholarships. Each applicant is given a code to keep the student's identity anonymous. It is therefore imperative that you "put your best foot forward" when presenting yourself through your essay. We strongly encourage you to create your essay in word processing software, such as Microsoft Word, which allows you to check spelling and grammar, then cut and paste that essay into the text box below.

Limit your essay to 400 words or less. Errors in your essay will be evident to the reviewers, so make the best impression by checking for accuracy before submitting your application! We will not correct your grammatical or spelling errors.

DO NOT INCLUDE YOUR NAME OR NAMES OF YOUR FAMILY MEMBERS IN YOUR ESSAY!

PERSONAL INFORMATION

Enter your name exactly as you would like it to appear on everything related to this scholarship program

Prefix
*

First Name
*

Middle Initial

Include a period, if you are entering your middle initial

Last Name
*

Suffix

Jr., II, III

Address
*

City
*

State
*

Zip
*

Must be at least 5 characters. Currently Used: 0 characters.

County
*

Home Phone
*

Enter in this format: XXX-XXX-XXXX

Cell Phone

Enter in this format: XXX-XXX-XXXX

Email
*

Provide an email address you will be checking frequently; preferably, one you will continue to use after you graduate from high school

High School and Guidance Counselor Information

School Name
*

School Address
*

School City
*

School State
*

School Zip
*

Maximum Allowed: 10 characters. Currently Used: 0 characters.

School Phone
*

Enter in this format: XXX-XXX-XXXX

The 200 Club will contact your Guidance Counselor through the email address you provide below so BE SURE IT IS ACCURATE. Alert your Guidance Counselor to let them know that they will be receiving an email TODAY with a link to an on-line form that they will complete to provide information on your behalf.

DO NOT SEND ANY SCHOLASTIC REPORTS TO US BY EMAIL OR MAIL. THEY WILL NOT BE ACCEPTED.

Guidance Counselor Full Name
*

Guidance Counselor Phone
*

Enter in this format: XXX-XXX-XXXX

Guidance Counselor Email
*

The 200 Club will contact one person you designate as an ACADEMIC REFERENCE. This can be your Guidance Counselor or a Teacher. We will contact them through the email address you provide below so BE SURE IT IS ACCURATE. Alert this person to let them know they will be receiving an email TODAY with a link to an on-line form that they will complete to provide information on your behalf.

DO NOT SEND ANY REFERENCE LETTERS TO US BY EMAIL OR MAIL. THEY WILL NOT BE ACCEPTED.

Academic Reference Full Name
*

Academic Reference Phone
*

Enter in this format: XXX-XXX-XXXX

Academic Reference Email
*

Departments Served / By Whom

Applications will be limited to one of the following:

1) High school seniors whose parent actively serves Morris County in a law enforcement/public safety capacity, or whose parent has retired and has satisfied their agency’s retirement eligibility requirements, or;

2) High school seniors who volunteer in one of the following branches of law enforcement or public safety:
• Police and Law Enforcement, including Federal and State agencies
• Fire Department (including volunteer fire fighters)
• Volunteer Ambulance Corps/First Aid Squads

Eligibility is limited to the children of law enforcement and public safety personnel or high school seniors engaged in the branches reflected above. State Police eligibility is restricted to those who live or have their primary assignment in Morris County.

Children of personnel working in clerical or other non-related public safety duties are not eligible. Likewise, children of members of The 200 Club of Morris County are not eligible.

Please check the eligibility criteria below.

Confirmation of eligibility
*

I volunteer with a local public safety agency (fire, police, EMS)My parent serves with a Morris County law enforcement/public safety agencyMy parent retired from a Morris County law enforcement/public safety agency and satisfied their retirement eligibility requirementsMy parent serves with the NJ State Police and we live or he/she has their primary assignment in Morris CountyMy parent retired from the NJ State Police and satisfied the agency's retirement eligibility requirements

Pub Safety Dept 1
*

Pub Safety Dept 1 Phone
*

Enter in this format: XXX-XXX-XXXX

Pub Safety Dept 1 Affiliation
*

Pub Safety Dept 2

Pub Safety Dept 2 Phone

Enter in this format: XXX-XXX-XXXX

Pub Safety Dept 2 Affiliation

Pub Safety Dept 3

Pub Safety Dept 3 Phone

Enter in this format: XXX-XXX-XXXX

Pub Safety Dept 3 Affiliation

Retired PS Officer Info

If your parent is a retired public safety officer, enter this information as follows:
Rank and Full Name
Department Name
Department Phone Number
Year of Retirement

Student's Employment History

Employer 1 Name

Name of your employer

Employer 1 Job Title

Your Position (i.e., Cashier, Waitress, Babysitter)

Years Worked at Employer 1

When did you work here? Example: 2009-2011
DO NOT ENTER MONTHS

Hours Worked at Employer 1

Hours Per Week (Enter the number of hours only)

Duration of Work at Employer 1

Select one

Employer 2 Name

Name of your employer

Employer 2 Job Title

Your Position (i.e., Cashier, Waitress, Babysitter)

Years Worked at Employer 2

When did you work here? Example: 2009-2011
DO NOT ENTER MONTHS

Hours Worked at Employer 2

Hours Per Week (Enter the number of hours only)

Duration of Work at Employer 2

Select one

Employer 3 Name

Name of your employer

Employer 3 Job Title

Your Position (i.e., Cashier, Waitress, Babysitter)

Years Worked at Employer 3

When did you work here? Example: 2009-2011
DO NOT ENTER MONTHS

Hours Worked at Employer 3

Hours Per Week (Enter the number of hours only)

Duration of Work at Employer 3

Select one

Extra Curricular Activities and Community Service

In order of importance. Be sure to enter complete information for each activity.

Activity 1

Maximum Allowed: 55 characters. Currently Used: 0 characters.

Activity 1 Years

What years? Example: 2010-2011
DO NOT ENTER MONTHS

Activity 1 Hours

Hours Per Week (Enter the number of hours only)

Duration of Activity 1

Select one

Activity 2

Maximum Allowed: 55 characters. Currently Used: 0 characters.

Activity 2 Years

What years? Example: 2010-2011
DO NOT ENTER MONTHS

Activity 2 Hours

Hours Per Week (Enter the number of hours only)

Duration of Activity 2

Select one

Activity 3

Maximum Allowed: 55 characters. Currently Used: 0 characters.

Activity 3 Years

What years? Example: 2010-2011
DO NOT ENTER MONTHS

Activity 3 Hours

Hours Per Week (Enter the number of hours only)

Duration of Activity 3

Select one

Activity 4

Maximum Allowed: 55 characters. Currently Used: 0 characters.

Activity 4 Years

What years? Example: 2010-2011
DO NOT ENTER MONTHS

Activity 4 Hours

Hours Per Week (Enter the number of hours only)

Duration of Activity 4

Select one

Activity 5

Maximum Allowed: 55 characters. Currently Used: 0 characters.

Activity 5 Years

What years? Example: 2010-2011
DO NOT ENTER MONTHS

Activity 5 Hours

Hours Per Week (Enter the number of hours only)

Duration of Activity 5

Select one

Activity 6

Maximum Allowed: 55 characters. Currently Used: 0 characters.

Activity 6 Years

What years? Example: 2010-2011
DO NOT ENTER MONTHS

Activity 6 Hours

Hours Per Week (Enter the number of hours only)

Duration of Activity 6

Select one

Colleges Applied To & Estimated Annual Costs

College 1 Applied to

College 1 Estimated Annual Costs

Round up to whole dollars. For example, 24,200

College 2 Applied to

College 2 Estimated Annual Costs

Round up to whole dollars. For example, 24,200

College 3 Applied to

College 3 Estimated Annual Costs

Round up to whole dollars. For example, 24,200

Your Essay (400 words or less)

Errors in your essay will be evident to the reviewers, so make the best impression by checking for accuracy before submitting your application! We will not correct your grammatical or spelling errors. DO NOT INCLUDE YOUR NAME OR NAMES OF YOUR FAMILY MEMBERS IN YOUR ESSAY!

Essay
*

Maximum Allowed: 400 words. Currently Used: 0 words.

DO NOT INCLUDE YOUR NAME OR NAMES OF YOUR FAMILY MEMBERS IN YOUR ESSAY!

Scholarship Program Information

Deadline for completed applications: March 1, 2018.

In accordance with our Club's policies, all scholarship recipients must furnish proof of enrollment in a college, university, etc., to Lori Richmond, Club Administrator, no later than October 1, 2018. If we do not receive this information by that date, it will be necessary to issue a Form 1099 showing that you received these funds as income, and not as a scholarship grant. You would then be obligated to report that as income and may be obligated to pay taxes on that amount for 2018.

I understand that if I am awarded a scholarship, I hereby grant The 200 Club of Morris County, its parent, subsidiaries, affiliates, licensees, successors and assigns, and those acting under their authority (collectively, The 200 Club of Morris County), to record, photograph, film, tape or otherwise capture my name, likeness, photograph, voice, actions and biography (collectively, “Likeness”), and to use, and to authorize others to use, my likeness, forever throughout the world. The 200 Club of Morris County may use my likeness in print, television, radio, film, internet and in all other media now known or hereafter existing for external and internal communications, public and private, including without limitation, publicity and promotion.

I waive the right to inspect or approve any such use of my likeness. The 200 Club of Morris County, will be under no obligation to actually use my likeness. I have received good consideration for this personal release, and no additional compensation is due to me ever.

I release The 200 Club of Morris County, its officers, directors, agents, trustees, successors, assignees and employees from all claims and liabilities of any kind arising out of or in connection with the making or use of my likeness, including without limitation, claims based upon invasion of privacy, defamation, or right of publicity.